| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $30.60 | $30.60 | $38.86 | |
Aetna
| Professional | $30.60 | $30.60 | $30.60 | |
Martin's Point
| Facility | $30.60 | $30.60 | $38.86 | |
Martin's Point
| Professional | $28.80 | $30.60 | $30.60 |